The incidence of irregular astigmatism has increased with the increasing popularity of refractive surgery. Irregular astigmatism can also be naturally occurring or induced by trauma, surgery or infection. Surgical and non-surgical approaches have been tried for its correction. Techniques for correction of irregular astigmatism with excimer laser include: 1) Selective Zonal Ablations, 2) Excimer Laser Assisted by Sodium Hyaluronate (ELASHY), 3) Topographic Linked excimer laser ablation (TOPOLINK), 4) Wave front guided refractive surgery. There is no universal agreement on a single technique. The technical evolution and the surgical experience are the hope for such patients.